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Ectopic and Tubal Pregnancies

An ectopic pregnancy is a complication that occurs immediately after a woman becomes pregnant. Ectopic means "out of place." During an ectopic pregnancy, the developing embryo does not attach to the uterus. Instead, the embryo attaches somewhere outside of the uterus, where it can cause a number of complications.

Tubal Pregnancy

The most common site for an ectopic pregnancy is in one of the fallopian tubes—the tubes that connect the ovaries to the uterus. When this occurs, an ectopic pregnancy is often called a tubal pregnancy. The terms tubal pregnancy and ectopic pregnancy are often used interchangeably.

Over 95 percent of ectopic pregnancies are tubal pregnancies. While much less common than a tubal pregnancy, ectopic pregnancies can also occur in the ovaries, the cervix and even the abdomen.

Tubal Pregnancy Risk Factors and Causes

An obstruction that blocks or slows the fertilized egg's path through the fallopian tubes is the most common cause of tubal pregnancies. Risk factors include tubal defects, complications from endometriosis, abdominal or pelvic surgery or the use of an intrauterine contraceptive device (IUD).

Complications from a ruptured appendix may also cause tubal twisting, or "kinking." Some assisted reproduction techniques for women who have had difficulty getting pregnant may also increase the risk of ectopic pregnancies.

Etopic Pregnancy Signs of an Ectopic Pregnancy
In most cases, an ectopic pregnancy causes few symptoms. The embryo usually dies quickly, and the woman resumes her menstrual period. In such cases, ectopic pregnancy symptoms may be limited to minor bleeding. If the woman is in the process of getting pregnant, she may believe she has suffered a miscarriage. As a result, a tubal pregnancy is rarely diagnosed.

When symptoms of a tubal pregnancy develop, initial symptoms often resemble the typical symptoms of pregnancy: cessation of menstruation, nausea, lower back pain and breast tenderness.

Symptoms that indicate complications of an ectopic pregnancy include pain, vaginal bleeding and cramping on the side of the pelvis where the tubal pregnancy is located.

Ectopic Pregnancy Complications

A tubal pregnancy is considered a pregnancy complication. An ectopic pregnancy cannot result in a healthy baby. As they grow, the ectopic cells can cause life-threatening complications to the mother. If not removed, the developing embryo continues to grow and can rupture fallopian tube membranes, causing internal bleeding.

Women using oral progesterone contraceptives have five times the normal risk of ectopic pregnancies should they get pregnant in spite of the contraceptive use.

Diagnosis of Tubal Pregnancy

As symptoms of tubal pregnancy are similar to those of a normal pregnancy, the diagnosis of ectopic pregnancy by symptoms alone is insufficient. Blood tests will reveal hCG, a hormone associated with pregnancy, but hCG levels will not rise as quickly as those in a healthy pregnancy.

If the symptoms of pregnancy do not correlate with the hCG levels, ultrasound is employed. Symptoms of pregnancy coupled with an ultrasound revealing an empty uterus indicates a tubal pregnancy.

Treatment of Ectopic Pregnancy

Methotrexate can dissolve ectopic cells and prevent severe tubal scarring if the ectopic pregnancy is uncomplicated. If tubal membranes rupture, surgery is required to stop bleeding and may require the removal of the affected fallopian tube.

Getting Pregnant after a Tubal Pregnancy

Having a tubal or ectopic pregnancy doesn't preclude the possibility of becoming pregnant. However, treatment of the ectopic pregnancy may cause complications. An estimated 85 percent of women who experience a tubal pregnancy are still capable of getting pregnant, although the risk of future ectopic complications runs between ten to twenty percent.

If a tubal pregnancy requires the removal of a fallopian tube, a woman still has a fifty percent chance of getting pregnant. Women who experience tubal pregnancies should wait three months before attempting to become pregnant again in order to let the body heal.

Resources

Beers, M. H., & Berkow, R., eds. (1999). Normal pregnancy, labor, and delivery. The Merck Manual of Diagnosis and Therapy, 17th Edition. NJ: Merck Research Laboratories.

Callahan, T. L., Caughey, A. B., & Heffner, L. J. (2001). Blueprints in Obstetrics and Gynecology, 2nd Edition. MA: Blackwell Publishing.

Kidshealth.org. (updated 2005). Ectopic pregnancy.

Walker, J. (nd). A detailed account of ectopic pregnancies.

U.S. National Library of Medicine. (updated 2004). Ectopic pregnancy. MedlinePlus Medical Encyclopedia.